BACKGROUND: Heart failure affects nearly 65 million people globally, resulting in recurrent hospital admissions and substantial healthcare expenditure. The use of morphine in the management of acute pulmonary oedema remains controversial, with conflicting guidance and significant variation in practice. Synthesised evidence is needed to inform standard treatment guidelines and clinical practice. OBJECTIVE: To determine whether morphine should be used in the treatment of acute pulmonary oedema (APE) in adults. METHODS: A rapid review of systematic reviews of randomised controlled trials or observational studies, and then randomised controlled trials, was conducted searching three electronic databases (PubMed, Embase, Cochrane Library) and one clinical trial registry on 12 February 2022. We used a prespecified protocol following Cochrane rapid review methods and aligned to the National Standard Treatment Guidelines and Essential Medicines List methodology. We first considered relevant high-quality systematic reviews of randomised controlled trials or observational studies, then (if required) randomised controlled trials to inform time-sensitive or urgent evidence requests, clinical practice, policy, or standard treatment guidelines. RESULTS: We identified four systematic reviews of observational studies. The two most relevant, up-to-date, and highest-quality reviews were used to inform evidence for critical outcomes. Morphine may increase in-hospital mortality (odds ratio (OR) 1.78; 95% confidence interval (CI) 1.01 - 3.13; low certainty of evidence; six observational studies, n=151 735 participants), resulting in 15 more per 1 000 hospital deaths, ranging from 0 to 40 more hospital deaths. Morphine may result in a large increase in invasive mechanical ventilation (OR 2.72; 95% CI 1.09 - 6.80; low certainty of evidence; four observational studies, n=167 847 participants), resulting in 45 more per 1 000 ventilations, ranging from 2 more to 136 more. Adverse events and hospital length of stay were not measured across reviews or trials. CONCLUSION: Based on the most recent, relevant and best-available quality evidence, morphine use in adults with APE may increase in-hospital and all-cause mortality and may result in a large increase in the need for invasive mechanical ventilation compared to not using morphine. Recommending against the use of morphine in pulmonary oedema may improve patient outcomes. Disinvesting in morphine for this indication may result in cost savings, noting the possible accrued benefits of fewer patients requiring invasive ventilation and management of morphine-related side-effects.

BACKGROUND: Previous studies have reported comorbid disease, including hypertension, diabetes mellitus, chronic cardiac and renal disease, malignancy, HIV, tuberculosis (TB) and obesity, to be associated with COVID-19 mortality. National demographic surveys have reported a high proportion of undiagnosed and untreated comorbid disease in South Africa (SA OBJECTIVES: To determine the number of individuals with previously undiagnosed HIV, TB and non-communicable diseases (NCDs) among patients hospitalised with COVID-19, and the level of medical control of these chronic diseases METHODS: We conducted a sentinel surveillance study to collect enhanced data on HIV, TB and NCDs among individuals with COVID-19 admitted to 16 secondary-level public hospitals in six of the nine provinces of SA. Trained surveillance officers approached all patients who met the surveillance case definition for inclusion in the study, and consenting patients were enrolled. The data collection instrument included questions on past medical history to determine the self-reported presence of comorbidities. The results of clinical and laboratory testing introduced as part of routine clinical care for hospitalised COVID-19 patients were collected for the study, to objectively determine the presence of hypertension, diabetes, HIV and TB and the levels of control of diabetes and HIV RESULTS: On self-reported history, the most prevalent comorbidities were hypertension (n=1 658; 51.5%), diabetes (n=855; 26.6%) and HIV (n=603; 18.7%). The prevalence of self-reported active TB was 3.1%, and that of previous TB 5.5%. There were 1 254 patients admitted with COVID-19 (39.0%) who met the body mass index criteria for obesity. On clinical and laboratory testing, 87 patients were newly diagnosed with HIV, 29 with TB, 215 with diabetes and 40 with hypertension during their COVID-19 admission. There were 151/521 patients living with HIV (29.0%) with a viral load >1 000 copies/mL and 309/570 (54.2%) with a CD4 count <200 cells/μL. Among 901 patients classified as having diabetes, 777 (86.2%) had a glycated haemoglobin (HbA1c) level >6.5% CONCLUSION: The study revealed a high prevalence of comorbid conditions among individuals with COVID-19 admitted to public hospitals in SA. In addition, a significant number of patients had previously undiagnosed hypertension, diabetes, HIV and active TB, and many had poorly controlled chronic disease, as evidenced by high HbA1c levels in patients with diabetes, and high viral loads and low CD4 levels in patients with HIV. The findings highlight the importance of strengthening health systems and care cascades for chronic disease management, which include prevention, screening for and effectively treating comorbidities, and ensuring secure and innovative supplies of medicines in primary healthcare during the COVID-19 pandemic

Abstract Introduction: In arid regions, soil losses are caused by torrential rainfall events and by the erosive energy of runoff. Objectives: To quantify the impact of the use of different types of vegetation cover on soil erosion and soil deposition caused by overland flow. Methodology: The experiment was carried out from July to September 2017 under a randomized block experimental design with three replications. The treatments evaluated were maize harvest residues and buffel grass (Cenchrus ciliaris L.) sowing (MHR + G), maize harvest residues (MHR), buffel grass sowing (G), and the control (C). Results: The MHR + G treatment reduced erosion by 44 % (26.3 t·ha-1) compared to the control (58.6 t·ha-1). Soil deposition was 47.6 and 51.7 t·ha-1 with MHR + G and G, respectively, while in C was 26.1 t·ha-1. Limitations of the study: The results found are valid for the soil and water conditions of this study Originality: There are few technical and scientific reports on the behavior of soil particle removal and deposition processes under runoff conditions. Conclusions: The layer thickness of soil removed and deposited, under overland flow conditions, depends on the type of soil cover. The MHR + G treatment significantly reduced soil erosion, making it a viable alternative.

Resumen Introducción: En regiones áridas, las pérdidas de suelo son ocasionadas por eventos pluviales torrenciales y por la energía erosiva de los escurrimientos hídricos superficiales. Objetivos: Cuantificar el impacto del uso de diferentes tipos de cobertura vegetal sobre la erosión-deposición del suelo causada por el flujo laminar. Metodología: El experimento se llevó a cabo de julio a septiembre de 2017 bajo un diseño experimental de bloques al azar con tres repeticiones. Los tratamientos evaluados fueron: residuos de cosecha de maíz y siembra de zacate buffel (Cenchrus ciliaris L.) (R+Z), residuos de cosecha de maíz (R), siembra de zacate buffel (Z) y testigo (T). Resultados. El tratamiento R+Z redujo la erosión en un 44 % (26.3 t·ha-1) con respecto al testigo (58.6 t·ha-1). La deposición de suelo fue de 47.6 y 51.7 t·ha-1 con R+Z y Z, respectivamente, mientras que en el T fue de 26.1 t·ha-1. Limitaciones del estudio: Los resultados obtenidos son válidos para las condiciones del suelo e hídricas de este estudio. Originalidad: Existen pocos reportes técnicos y científicos sobre el comportamiento de los procesos de remoción y deposición de partículas de suelo bajo condiciones de escurrimiento superficial. Conclusiones: El espesor de la capa de suelo removida y depositada, bajo condiciones de flujo laminar, depende del tipo de cobertura del suelo. El tratamiento R+Z redujo significativamente la erosión del suelo, convirtiéndolo en una alternativa viable.

By May 2021, South Africa (SA) had experienced two 'waves' of COVID-19 infections, with an initial peak of infections reached in July 2020, followed by a larger peak of infections in January 2021. Public health decisions rely on accurate and timely disease surveillance and epidemiological analyses, and accessibility of data at all levels of government is critical to inform stakeholders to respond effectively. In this paper, we describe the adaptation, development and operation of epidemiological surveillance and modelling systems in SA in response to the COVID-19 epidemic, including data systems for monitoring laboratory-confirmed COVID-19 cases, hospitalisations, mortality and recoveries at a national and provincial level, and how these systems were used to inform modelling projections and public health decisions. Detailed descriptions on the characteristics and completeness of individual datasets are not provided in this paper. Rapid development of robust data systems was necessary to support the response to the SA COVID-19 epidemic. These systems produced data streams that were used in decision-making at all levels of government. While much progress was made in producing epidemiological data, challenges remain to be overcome to address gaps to better prepare for future waves of COVID-19 and other health emergencies.

RESUMO Objetivo: Avaliar o conhecimento, atitudes e práticas em relação à COVID-19 entre profissionais de saúde atuantes em países da América Latina durante o primeiro surto da pandemia. Métodos: Estudo multinacional transversal com uso de questionário on-line autoaplicável. A versão final do questionário foi composta por 40 perguntas, organizadas em cinco seções: características demográficas e profissionais; conhecimento sobre COVID-19; atitudes em relação à COVID-19; práticas relacionadas à COVID-19; e recursos institucionais. Resultados: O estudo envolveu 251 profissionais de saúde de 19 países da América Latina que aceitaram participar. Em nossa amostra, 77% dos profissionais de saúde participaram de algum tipo de treinamento institucional sobre COVID-19 e 43% tiveram baixa pontuação de conhecimento sobre COVID-19. O conhecimento sobre COVID-19 apresentou associação com o tipo de instituição de saúde (pública/privada), disponibilidade de treinamento institucional e fontes de informação. Receio de não prestar atendimento adequado foi relatado por 60% dos participantes. As estratégias ventilatórias mais utilizadas foram ventilação mecânica protetora, manobras de recrutamento alveolar e posição prona, e o uso de medicamentos para tratar a COVID-19 foi baseado principalmente em protocolos institucionais. Conclusões: Neste estudo multinacional na América Latina, quase metade da amostra teve baixa pontuação de conhecimento sobre COVID-19 e o nível de conhecimento apresentou associação com o tipo de instituição, participação em treinamento institucional e fontes de informação. Os profissionais de saúde consideravam a COVID-19 muito relevante, e mais da metade tinha receio de não prestar atendimento adequado aos pacientes.

ABSTRACT Objective: To evaluate COVID-19 knowledge, attitudes, and practices among health care workers (HCWs) practicing in Latin American countries during the first surge of the COVID-19 pandemic. Methods: This was a multinational cross-sectional survey study, using an online self-administered questionnaire. The final version of the questionnaire comprised 40 questions, organized in five sections: demographic and professional characteristics; COVID-19 knowledge; attitudes toward COVID-19; COVID-19 practices; and institutional resources. Results: The study involved 251 HCWs from 19 Latin American countries who agreed to participate. In our sample, 77% of HCWs participated in some sort of institutional training on COVID-19, and 43% had a low COVID-19 knowledge score. COVID-19 knowledge was associated with the type of health center (public/private), availability of institutional training, and sources of information about COVID-19. Concerns about not providing adequate care were reported by 60% of the participants. The most commonly used ventilatory strategies were protective mechanical ventilation, alveolar recruitment maneuvers, and prone positioning, and the use of drugs to treat COVID-19 was mainly based on institutional protocols. Conclusions: In this multinational study in Latin America, almost half of HCWs had a low COVID-19 knowledge score, and the level of knowledge was associated with the type of institution, participation in institutional training, and information sources. HCWs considered that COVID-19 was very relevant, and more than half were concerned about not providing adequate care to patients.

BACKGROUND: The phenomenon of silent hypoxaemia has been described in patients with COVID-19 pneumonia, which is characterised by low oxygen saturation levels of <90% in those who appear clinically well and do not show signs of significant respiratory distress.OBJECTIVES: To assess the impact on clinical outcomes for high-risk COVID-19 patients using a pulse oximeter to monitor oxygen saturation levels in a home setting.METHODS: We performed a retrospective cohort analysis using data from a large South African insurance administrator. Patients were categorised as high risk, based on age and specific underlying clinical conditions, or from predictive models derived from medical scheme administrative claims data. The impact of pulse oximetry home monitoring on COVID-19 clinical outcomes was investigated by the use of Cox proportional hazard models.RESULTS: Between 2 March 2020 and 31 October 2020, of 38 660 patients analysed, 8 115 were in the intervention group. The 60-day mortality rate for the evaluated high-risk population was 1.35%. After adjusting for age and comorbidity differences, the intervention group was found to have an adjusted hazard ratio of 0.52 (p<0.0001). No statistical significance was found between the intervened and control groups for admission to hospital, admission to intensive care unit (ICU) and use of mechanical ventilation. The intervention group had a lower median C-reactive protein (CRP) level on admission (p=0.03). After adjustment for admission CRP levels, elevated CRP was associated with an increased mortality (p<0.0001), while the statistical significance in mortality between the intervention and the control group was lost.CONCLUSIONS: High-risk COVID-19 patients who used a pulse oximeter to monitor oxygen saturation levels had significantly lower mortality rates compared with other high-risk patients. The mortality benefit may be explained by earlier presentation to hospital, as suggested by lower initial CRP levels.

RESUMEN La mina Cunas es actualmente una de las principales productoras de esmeraldas de alta calidad en Colombia. Sus gemas se caracterizan por un intenso tono verde muy apreciado en el mercado mundial. La mineralización se encuentra en lodolitas negras, ricas en vanadio, de la formación Muzo. Las esmeraldas se encuentran al interior de venas hidrotermales y brechas, compuestas principalmente por calcita, dolomita, albita, cuarzo y, en menor medida, pirita, parisita- (Ce) y fluorita. La alteración hidrotermal asociada es pervasiva y está dominada por la albitización y la carbonatización. Las inclusiones fluidas alojadas en esmeraldas son muy abundantes, de gran tamaño y alta complejidad. Las inclusiones fluidas polifásicas son ubicuas, ocurren tanto en esmeraldas como en minerales de ganga, y generalmente están compuestas por dos cristales hijos (típicamente halita y calcita o siderita; excepcionalmente parisita- (Ce)), una salmuera, un gas rico en CO2-N2-CH4, y ocasionalmente CO2 líquido. También se observaron inclusiones ricas en vapor en cuarzo y se identificaron inclusiones bifásicas en calcita y dolomita, lo que sugiere una evolución de fluido compleja. El análisis de microtermometría indica que los fluidos formadores de esmeraldas quedaron atrapados a una temperatura relativamente baja = 260-340 ° C y una presión = 875-2400 bar, con una densidad relativamente alta -1,03 g / cm3- y una salinidad elevada de 39% NaCl eq. peso; otros componentes acuosos detectados fueron CaCl2, KCl y FeCl2. Con base en estos datos, los autores proponen que la mineralización de esmeraldas en la mina Cunas se originó por la mezcla de dos fluidos hidrotermales de diferentes fuentes. Un fluido con alta salinidad derivado de la disolución de evaporitas, el cual es responsable de la albitización de las rocas hospedantes. El segundo es un fluido rico en calcio derivado de aguas connadas, que fue equilibrado por la interacción con rocas calcáreas y carbonosas. Como resultado, la mineralización de esmeraldas ocurrió en sitios estructuralmente favorables donde se promovió la mezcla de fluidos. Las características geológicas y fisicoquímicas descritas para la mina Cunas, están de acuerdo con una mineralización epigenética alojada en sedimentos "tipo colombiano" formada por la circulación y mezcla de fluidos no magmáticos de temperatura relativamente baja.

ABSTRACT The Cunas mine is currently one of the major producers of fine emeralds in Colombia; its emeralds typically display a magnificent green hue, which is highly appreciated globally. The mineralization is found in vanadium-rich black shales of the Muzo formation. Emeralds occur in pockets within hydrothermal veins and breccias, mainly consisting of calcite, dolomite, albite, quartz, minor pyrite, parisite-(Ce), and fluorite. Hydrothermal alteration is pervasive and dominated by albitization and carbonatization. Emerald-hosted fluid inclusions are highly abundant and remarkably large and complex. Poly-phase inclusions are ubiquitous, occur both in emeralds and gangue minerals, and consist of two daughter crystals (typically halite and calcite or siderite; exceptionally parisite-(Ce)), a liquid brine, a CO2-N2-CH4-rich gas bubble, and occasionally minor liquid CO2. Vapor-rich inclusions were observed in quartz, and two-phase inclusions were identified in calcite and dolomite, thus suggesting a complex fluid evolution. Microthermometry analysis indicates that emerald-forming fluids were trapped at relatively low temperature ~260-340°C and pressure ~850-2400 bar, with relatively high density 1.03 g/cm3, and elevated salinity ~39 wt% NaCl eq.; other aqueous components detected include CaCl2, KCl, and FeCl2. Based on these data, authors propose the emerald mineralization at the Cunas mine was originated by the mixing of two hydrothermal fluids of different sources; one fluid with high salinity derived from evaporite dissolution, responsible for the albitization of the host rocks; the second is a calcium-rich fluid evolved from connate waters, which was equilibrated by the interaction with calcareous and organic-rich wall rocks. As a result, emerald mineralization took place at structurally favorable sites proper for fluid mixing. The described geological and physicochemical features for the Cunas mine agree with epigenetic sediment-hosted mineralization -Colombian-type- formed by the circulation and mixing of relatively low-temperature non-magmatic fluids.

Resumo Objetivo Quantificar a concentração urinária do biomarcador telopeptídeo C de ligação cruzada de colágeno de tipo II (C-terminal cross-linked telopeptide of type-II collagen, CTX-II) em casos de lesão isolada do ligamento cruzado anterior (LCA), e comparar as concentrações observadas nessa população com um grupo controle composto por pacientes sem alterações metabólicas no joelho que possam levar à degeneração da cartilagem. Métodos Este é um estudo piloto transversal com dois grupos: pacientes com ruptura do LCA e grupo controle (cada grupo era composto por 10 indivíduos do sexo masculino, com 18 a 35 anos de idade, e índice de massa corporal inferior a 30 kg/m2). Nos dois grupos, as concentrações urinárias de um biomarcador relacionado à degradação do colágeno de tipo II (CTX-II) foram medidas. No grupo com ruptura do LCA, a relação entre o tempo pós-lesão e a quantidade do biomarcador também foi analisada. Resultados Houve diferenças significativas nas concentrações urinárias de CTX-II entre o grupo LCA e o grupo controle (p = 0,009). Não foi observada relação significativa entre o tempo de lesão e a quantidade do biomarcador. Conclusões Pacientes com lesão do LCA apresentaram maiores concentrações urinárias do biomarcador CTX-II do que aqueles sem lesão do LCA (p = 0,009). No entanto, não houve correlação entre a concentração desse biomarcador e o tempo decorrido após a lesão (p≥ 0,05).

Abstract Objective The aim of the present study was to quantify the urinary concentration of the C-terminal cross-linked telopeptide of type-II collagen (CTX-II) biomarker in patients who suffered an isolated ACL injury, and to compare the concentrations found in this population with a control group of patients with no metabolic changes in the knee that could lead to cartilage degeneration. Methods A cross-sectional pilot study was performed in two groups: patients with ACL tears and a control group (each group with 10 male subjects, with an age range between 18 and 35 years, and body mass index below 30 kg/m2). In both groups, urine concentrations of a biomarker related to the degradation of type-II collagen (CTX-II) was measured. For the group with ACL tears, a temporal relationship between the time after the injury and the amount of the biomarker was also examined. Results There were significant differences in the concentrations of urinary CTX-II between the ACL group and the control group (p = 0.009). No significant relationship was observed between the time after the injury and the quantity of the biomarker. Conclusions Patients with ACL injury had higher concentrations of urinary CTX-II biomarker than those with no ACL injury (p = 0.009). However, there was no correlation between the concentration of this biomarker and the elapsed time after the injury (p≥ 0.05).

BACKGROUND. More comprehensive immunisation regimens, strengthening of HIV prevention and management programmes and improved socioeconomic conditions have impacted on the epidemiology of paediatric community-acquired pneumonia (CAP) in South Africa (SA). OBJECTIVES. To summarise effective preventive strategies to reduce the burden of childhood CAP. METHODS. An expert subgroup reviewed existing SA guidelines and new publications focusing on prevention. Published evidence on pneumonia prevention informed the revisions; in the absence of evidence, expert opinion was used. Evidence was graded using the British Thoracic Society (BTS) grading system. RECOMMENDATIONS. General measures for prevention include minimising exposure to tobacco smoke or air pollution, breastfeeding, optimising nutrition, optimising maternal health from pregnancy onwards, adequate antenatal care and improvement in socioeconomic and living conditions. Prevention of viral transmission, including SARS-CoV-2, can be achieved by hand hygiene, environmental decontamination, use of masks and isolation of infected people. Specific preventive measures include vaccines as contained in the Expanded Programme on Immunisation schedule, isoniazid prophylaxis for tuberculosis, co-trimoxazole prophylaxis for HIV-infected infants and children who are immunosuppressed, and timely diagnosis of HIV, as well as antiretroviral therapy (ART) initiation. HIV-infected children treated with ART from early infancy, and HIV-exposed children, have similar immunogenicity and immune responses to most childhood vaccines as HIV-unexposed infants. VALIDATION. These recommendations are based on available published evidence supplemented by the consensus opinion of SA paediatric experts, and are consistent with those in published international guidelines.

BACKGROUND. Pneumococcal conjugate vaccine (PCV) administration and other advances have been associated with a shift in the aetiological spectrum of community-acquired pneumonia, necessitating reconsideration of empiric antibiotic treatment guidelines. Management strategies have also evolved in the last decade. OBJECTIVES. To produce revised guidelines for the treatment of pneumonia in South African (SA) children, including ambulatory, hospital and intensive care management. METHODS. An expert subgroup, reviewing evidence on the management of childhood pneumonia, was convened as part of a broader group revising SA guidelines. Evidence was graded using the British Thoracic Society (BTS) grading system and recommendations were made. RESULTS. Antibiotic treatment depends on the child's age, possible aetiology, antimicrobial resistance patterns, previous treatment, as well as factors affecting host susceptibility, including HIV, and nutritional and vaccination status. All children with signs of severe pneumonia should receive antibiotics. Children <1 month of age with pneumonia should be hospitalised and treated with ampicillin and an aminoglycoside. For treatment of ambulatory children >1 month of age, high-dose amoxicillin remains the preferred antibiotic. For severe pneumonia in this age group, hospitalisation and empiric treatment with amoxicillin-clavulanate orally is recommended; if oral therapy is not tolerated, intravenous therapy is recommended. Generally, 5 days of therapy is proposed, but longer duration may be needed in cases of severe or complicated disease. A macrolide antibiotic should be used if pertussis, mycoplasma or chlamydia pneumonia is suspected. Most hypoxic children can receive oxygen via nasal cannulae, but respiratory support should be individualised and extends to non-invasive and invasive ventilation in some cases. Children should be fed enterally; if this is not possible, administer intravenous isotonic fluids at <80% of maintenance, with monitoring of sodium levels. Empiric antibiotic treatment is the same in HIV-infected, HIV-exposed uninfected and HIV-uninfected children, although treatment for pneumocystis pneumonia and/or cytomegalovirus pneumonia should be considered in HIV-infected infants, especially in the absence of combination antiretroviral therapy. CONCLUSIONS. Updated guidelines optimise the management of childhood pneumonia in the context of changing epidemiology, improvements in HIV prevention and new evidence on management.

ABSTRACT Wind erosion is the main problem that arid lands in northern Mexico are facing. Quantification of this phenomenon is crucial for planning purposes and to scale its impact. The challenge is to assess the problem under limited availability of climatic information. This study aimed to identify potential areas of dust emissions in an arid zone of Northern Mexico. Wind direction and intensity were characterized through a robust index that involves rainfall and evaporation as well as the climatic factor of the general wind erosion equation. A method for assessing the likelihood of dust emission associated with wind erosion was applied. Data from twelve weather stations within the region of the study was analyzed. The variables considered were wind velocity and direction, temperature, and precipitation. A wind rose of wind direction and intensity was obtained. Results showed that the Thornthwaite’s method for computing the Soil Moisture Index (SMI) is a good approach when computing the climatic factor C of the general function of the potential average annual soil loss. Given the lack of local evaporation data, the precipitation-evaporation ratio P E for each weather station was computed as an intermediate step towards the computation of C. Three of the analyzed climatic stations had intermediate C values (36-71 %) in the scale of wind erosion climatic factor. The wind velocities registered in these climatic stations ranged from 15 to 30 km h -1 . The magnitude-frequency analysis of the P E parameter for the stations showed the differences in rainfall and evaporation regimes. Dust pollution prone areas were identified, showing areas where conservation strategies should be directed.

BACKGROUND: Although immunisation services are available to all children in South Africa (SA), many children miss or have delays in receiving vaccines. There are limited data on factors associated with missed or delayed vaccination in children in this setting.OBJECTIVES: To assess vaccination coverage and factors associated with missed and delayed diphtheria-tetanus-pertussis vaccine third dose (DTP3) vaccination in children aged 12 - 59 months in two SA communities.METHODS: We used data from household-level healthcare utilisation surveys conducted in Soweto in 2012 and in Pietermaritzburg in 2013. Information on vaccination status was recorded from the Road to Health cards or vaccination history from clinics for children aged <5 years. Factors associated with missed or delayed DTP3 vaccination were assessed using unconditional logistic regression.RESULTS: Of a total of 847 eligible children aged 12 - 59 months, 716 had available vaccination information. Overall DTP3 vaccination coverage was high for both sites: 90.6% in Pietermaritzburg and 93.9% in Soweto. However, 32.6% and 25.2% of DTP3 vaccinations were delayed (received after 18 weeks of age) in Pietermaritzburg and Soweto, respectively. The median delay for DTP3 vaccinations was 4.7 weeks (interquartile range 1.7 - 23.0). Factors associated with delayed DTP3 vaccination included being born in 2010 (adjusted odds ratio (aOR) 3.0, 95% confidence interval (CI) 1.4 - 6.3) or 2011 (aOR 2.7, 95% CI 1.3 - 5.7) compared with being born in 2008, probably due to vaccine shortages; a low level of education of the primary caregiver, with children whose caregivers had completed secondary education having lower odds of delayed vaccination (aOR 0.5, 95% CI 0.3 - 0.9) than children whose caregivers only had primary education; and maternal HIV status, with unknown status (aOR 3.5, 95% CI 1.6 - 7.6) associated with higher odds of delay than positive status. Factors associated with missed DTP3 vaccination (not vaccinated by 12 months of age) included two or more children aged <5 years in a household (aOR 2.4, 95% CI 1.2 - 4.9) compared with one child, and household monthly income <ZAR500 (aOR 3.4, 95% CI 1.1 - 11.4) compared with >ZAR2 000.CONCLUSIONS: Despite high overall DTP3 coverage observed in two communities, many vaccinations were delayed. Vulnerable groups identified in this study should be targeted with improved vaccination services to enhance uptake and timeliness of vaccination.

BACKGROUND: Public health facilities are used by the majority of South Africans, and healthcare utilisation surveys have been a useful tool to estimate the burden of disease in a given areaOBJECTIVES: To describe care-seeking behaviour in a periurban site with a high prevalence of HIV infection, as well as barriers to seeking appropriate healthcareMETHODS: We conducted a cross-sectional household survey in 22 wards of the Msunduzi municipality in KwaZulu-Natal Province, South Africa, from October to December 2013 using a simple random sample of households selected from a 2011 census enumeration. A primary caregiver/adult decision-maker was interviewed regarding demographic data as well as health status and recent self-reported episodes of selected illnesses and healthcare utilisationRESULTS: Of the 2 238 eligible premises visited, 1 936 households (87%) with a total of 9 733 members were enrolled in the study. Of these, 635 (7%) reported one or more episodes of infectious illness during the study period. Public health clinics were most frequently consulted for all illnesses (361/635, 57%). Private healthcare (general practitioner, private clinic, private hospital) was sought by 90/635 of individuals (14%), only 13/635 (2%) reported seeking care from traditional healers, religious leaders or volunteers, and 71/635 (11%) did not seek any medical care for acute illnesses. Individuals in the lowest income group were more likely to seek care at public health facilities than those in the highest income group (70% v. 32%CONCLUSIONS: Public health facility-based surveillance may be representative of disease patterns in this community, although surveillance at household level shows that high-income individuals may be excluded because they were more likely to use private healthcare, and the proportion of individuals who died at home would have been missed by facility-based surveillance. Data obtained in such surveys may be useful for public health planning

OBJECTIVES: We evaluated mRNA expression levels of genes that encode TGF-β1; the TGF-β1 receptor; the collagen-modifying enzymes LOX, PLOD1, and PLOD2; and the extracellular matrix proteins COMP, FN1, TNC and TNXB in synovial/capsule specimens from patients with idiopathic adhesive capsulitis. Possible associations between the measured mRNA levels and clinical parameters were also investigated. METHODS: We obtained glenohumeral joint synovium/capsule specimens from 9 patients with idiopathic adhesive capsulitis who had not shown improvement in symptoms after 5 months of physiotherapy. Adhesive capsulitis was confirmed in all patients by magnetic resonance imaging. We also obtained specimens from 8 control patients who had underwent surgery for acute acromioclavicular joint dislocation and who had radiological indication of glenohumeral capsule alteration based on arthroscopic evaluation. mRNA expression in the synovium/capsule specimens was analyzed by quantitative reverse transcription PCR. The B2M and HPRT1 genes were used as references to normalize target gene expression in the shoulder tissue samples. RESULTS: The synovium/capsule samples from the patients with adhesive capsulitis had significantly higher TNC and FN1 expression than those from the controls. Additionally, symptom duration directly correlated with expression of TGFβ1 receptor I. CONCLUSION: Elevated levels of TNC and FN1 expression may be a marker of capsule injury. Upregulation of TGFβ1 receptor I seems to be dependent on symptom duration; therefore, TGFβ signaling may be involved in adhesive capsulitis. As such, TNC, FN1 and TGFβ1 receptor I may also play roles in adhesive capsulitis by contributing to capsule inflammation and fibrosis.

Vaccination is the most effective strategy to prevent influenza. It is recommended that influenza vaccine be administered each year before the influenza season, i.e. from March to June, although for individuals at increased risk of severe influenza in whom vaccination was missed, vaccine may be administered later. For a review of the 2015 influenza season and ongoing real-time updates of the 2016 influenza season when it starts, refer to the website of the National Institute for Communicable Diseases of the National Health Laboratory Service (www.nicd.ac.za). In this article we provide recommendations for the use of influenza vaccines in anticipation of the 2016 southern hemisphere influenza season. Guidance is based on available evidence to assist clinicians in making decisions regarding influenza vaccination. It should be noted that this article includes general recommendations for vaccination with influenza vaccines available in South Africa and may differ from groups targeted in specific vaccination programmes, e.g. the National Department of Health Programme.